胃と腸52巻3号

2017年03月発行

今月の主題 表在型食道胃接合部癌の治療戦略 主題

食道胃接合部癌とBarrett食道腺癌の鑑別は必要か─臨床の立場から

著者： 大隅寛木¹ 藤崎順子¹ 河内洋² 大前雅実¹ 清水智樹¹ 由雄敏之¹ 石山晃世志¹ 平澤俊明¹ 土田知宏¹ 山本智理子² 山本頼正¹

所属機関： ¹がん研有明病院消化器内科 ²がん研有明病院病理部

ページ範囲：P.311 - P.318

要旨●背景：Siewert分類Type II食道胃接合部（EGJ）癌は，胃噴門部癌（GCA）とBarrett食道腺癌（BEA）が混在しているため，内視鏡粘膜下層剝離術（ESD）適応や治癒切除の定まった基準がない．目的：Siewert分類Type IIのEGJ癌ESD症例からみたBEAとGCAの臨床病理学的特徴を明らかにする．対象・方法：2006〜2014年まで当院でESDが行われたSiewert分類Type IIのEGJ癌139例（BEA 54例，GCA 85例）を対象とした．比較項目は患者背景，内視鏡所見，内視鏡治療成績とした．結果：平均年齢はBEA群が有意に若年であり，生活習慣病の各因子，重複癌に有意差はなく，異時多発癌はGCAが有意に高率であった．腫瘍長径はBEAが小さく，肉眼型はBEAは隆起型，GCAは陥凹型の割合が高率であった．RAC，食道裂孔ヘルニア率は有意にBEAが高率であり，腸上皮化生はGCAが高率であった．一括切除率，局所再発率，合併症は両群に有意差なく，治癒切除率は有意にBEAが低率であった．結論：Siewert分類Type IIのEGJ癌において，BEAはH. pylori陰性の若年者に多く，内視鏡治療の非治癒因子になりうる．

参考文献

1）日本食道学会（編）．食道癌取扱い規約，第11版．金原出版，2015

2）Kusano C, Gotoda T, Khor CJ, et al. Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan. J Gastroenterol Hepatol 23：1662-1665, 2008

3）Drahos J, Xiao Q, Risch HA, et al. Age-specific risk factor profiles of adenocarcinomas of the esophagus：A pooled analysis from the international BEACON consortium. Int J Cancer 138：55-64, 2016

4）Xie FJ, Zhang YP, Zheng QQ, et al. Helicobacter pylori infection and esophageal cancer risk：an updated meta-analysis. World J Gastroenterol 19：6098-6107, 2013

5）下田忠和．食道癌の「取扱い規約」と「診断・治療のガイドライン」食道癌取扱い規約改訂第10版の要点─病理学的立場．日臨 69（Suppl 6）：109-120, 2011

6）Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85：1457-1459, 1998

7）Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett's esophagus：the Prague C and M criteria. Gastroenterology 131：1392-1399, 2006

8）Chandrasoma P, Makarewicz K, Wickramasinghe K, et al. A proposal for a new validated histological definition of the gastroesophageal junction. Hum Pathol 37：40-47, 2006

9）Hoshihara Y, Kogure T. What are longitudinal vessels? Endoscopic observation and clinical significance of longitudinal vessels in the lower esophagus. Esophagus 3：145-150, 2006

10）Kusano C, Kaltenbach T, Shimazu T, et al. Can Western endoscopists identify the end of the lower esophageal palisade vessels as a landmark of esophagogastric junction? J Gastroenterol 44：842-846, 2009

11）日本胃癌学会（編）．胃癌取扱い規約，第14版．金原出版， 2010

12）Yagi K, Honda H, Yang JM, et al. Magnifying endoscopy in gastritis of the corpus. Endoscopy 37：660-666, 2005

13）Nunobe S, Nakanishi Y, Taniguchi H, et al. Two distinct pathways of tumorigenesis of adenocarcinomas of the esophagogastric junction, related or unrelated to intestinal metaplasia. Pathol Int 57：315-321, 2007

14）Thrift AP, Shaheen NJ, Gammon MD, et al. Obesity and risk of esophageal adenocarcinoma and Barrett's esophagus：a Mendelian randomization study. J Natl Cancer Inst 106：pii：dju252. doi：10.1093/jnci/dju252, 2014

15）Organisation for Economic Co-operation and Development. OECD Health Statistics 2016. http://www.oecd.org/els/health-　systems/health-data.htm（accessed December 7, 2016）

16）Fujiwara Y, Arakawa T. Epidemiology and clinical characteristics of GERD in the Japanese population. J Gastroenterol 44：518-534, 2009

17）Iijima K, Koike T, Abe Y, et al. Time series analysis of gastric acid secretion over a 20-year period in normal Japanese men. J Gastroenterol 50：853-861, 2015

18）Schneider JL, Corley DA. A review of the epidemiology of Barrett's oesophagus and oesophageal adenocarcinoma. Best Pract Res Clin Gastroenterol 29：29-39, 2015

19）Kato M, Nishida T, Yamamoto K, et al. Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer：a multicentre retrospective cohort study by Osaka University ESD study group. Gut 62：1425-1432, 2013

20）Fukase K, Kato M, Kikuchi S, et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer：an open-label, randomized controlled trial. Lancet 372：392-397, 2008

21）Andrici J, Tio M, Cox MR, et al. Meta-analysis：Barrett's oesophagus and the risk of colonic tumours. Aliment Pharmacol Ther 37：401-410, 2013

22）Brundler MA, Harrison JA, de Saussure B, et al. Lymphatic vessel density in the neoplastic progression of Barrett's oesophagus to adenocarcinoma. J Clin Pathol 59：191-195, 2006

23）大前雅実，藤崎順子，清水智樹，他．食道胃接合部領域の脈管密度．Gastroenterol Endosc 57（Suppl.1）：609, 2015

24）Abraham SC, Krasinskas AM, Correa AM, et al. Duplication of the muscularis mucosae in Barrett esophagus：an underrecognized feature and its implication for staging of adenocarcinoma. Am J Surg Pathol 31：1719-1725, 2007

25）Omae M, Fujisaki J, Horiuchi Y, et al. Safety, efficacy, and long-term outcomes for endoscopic submucosal dissection of early esophagogastric junction cancer. Gastric Cancer 16：147-154, 2013

26）Hoteya S, Matsui A, Iizuka T, et al. Comparison of the clinicopathological characteristics and results of endoscopic submucosal dissection for esophagogastric junction and non-junctional cancers. Digestion 87：29-33, 2013

27）Manner H, Pech O, Heldmann Y, et al. Efficacy, safety, and long-term results of endoscopic treatment for early stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol 11：630-635, 2013

28）Osumi H, Fujisaki J, Omae M, et al. Meta-analysis of lymph node metastasis in Siewert type I and II T1 adenocarcinomas. World J Meta-Anal 4：118-123, 2016

29）笹子三津留，木下平，丸山圭一．早期胃癌の予後．胃と腸 28：139-146, 1983

30）Siewert JR, Feith M, Werner M, et al. Adenocarcinoma of the esophagogastric junction：results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 232：353-361, 2000

31）Lee L, Ronellenfitsch U, Hofstetter WL, et al. Predicting lymph node metastases in early esophageal adenocarcinoma using a simple scoring system. J Am Coll Surg 217：191-199, 2013

32）Yamashita H, Katai H, Morita S, et al. Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Ann Surg 254：274-280, 2011